Evidence map›Paper›PMID 29178895›Full record

ArticleBMC psychiatry2017

Informed, advance refusals of treatment by people with severe mental illness in a randomised controlled trial of joint crisis plans: demand, content and correlates.

Claire Henderson, Simone Farrelly, Clare Flach, Rohan Borschmann, Max Birchwood, Graham Thornicroft, Waquas Waheed, George Szmukler

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Claire HendersonHealth Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. claire.1.henderson@kcl.ac.uk.ORCID 0000-0002-6998-5659
Simone FarrellyHealth Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Clare FlachMedical Statistics Unit, Health and Social Care Research, King's College London, London, UK.
Rohan BorschmannHealth Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Max BirchwoodSchool of Psychology, University of Birmingham, Birmingham, UK.
Graham ThornicroftHealth Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Waquas WaheedDivision of Psychiatry, School of Medicine, University of Manchester, Manchester, UK.
George SzmuklerHealth Service and Population Research Department, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.

Funding

Department of HealthMedical Research Council
6 · The paper itself

Abstract

backgroundIn the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics.

methodsTo identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data.

resultsNinety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission.

conclusionsWe demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans.

trial registrationISRCTN11501328 Registered 13th March 2008.

Indexed as

AdultBipolar DisorderCoercionCrisis InterventionEnglandFactor Analysis, StatisticalFemaleHealth Services Needs and DemandHospitalizationHumansInformed ConsentMaleMental DisordersPatient Care PlanningPsychotic DisordersRandomized Controlled Trials as Topic

Identifiers

PMID29178895
PMCPMC5702102

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.